Care home quality and 'inappropriate' emergency healthcare use-failing to engage with complexity.

Care home residents are more likely to experience unplanned, emergency healthcare than those living elsewhere in the community. This can be potentially burdensome for both individual residents and healthcare systems. Academic and policy attention has focussed on quantifying this resource use, exploring potential causes and reducing unplanned emergency healthcare. Considerable attention has been placed on emergency healthcare that may be 'inappropriate' or 'avoidable'. In this commentary, we problematise such concepts. We suggest that the absence of an agreed definition can lead to wide variation in estimations which fail to acknowledge the complexity of care home residents' needs and their right to timely healthcare support. We draw attention to the impact of popular discourse in this area as potentially stigmatising to care home organisations, staff and residents. We argue that emergency healthcare use data alone is insufficient to measure and evaluate the quality of care provided by care homes. We propose a move away from over-simplistic distinctions, between emergency healthcare that is or is not 'appropriate', to develop more nuanced conceptualisations that account for the complexity involved in providing healthcare support to people living in care homes. People living in care homes have significant healthcare needs. It is necessary that models of care supporting homes are resourced to respond and support care home professionals. Rather than focusing solely on quantifying emergency healthcare use, acknowledging and embracing complexity will help to refocus our efforts and redesign our services around both individual and population needs, rather than around existing systems.